‘To Give or Not To Give’

As medical students, we should all know about the legal regulations surrounding key aspects of medicine, The Welsh Government published the Draft Human Transplantation Act in June 2012 [1]. It proposes that Welsh residents give presumed consent for organ donation unless they ‘opt out’ of the system.

In order to be passed, the draft bill must first be introduced into the assembly, go through all 4 stages of scrutiny and then be presented for Royal Assent. Ministers aim for the law to be in place by 2015.

‘Deemed consent’ will apply to any person over the age of 18 who has lived in Wales for at least 6 months. However there are a number of controversies surrounding the proposed bill:

• Is it fair that the organs will be available to anyone on the UK waiting list, not specifically for welsh patients?
• How much effort will the ‘opt out’ process involve and how long it will take?
• With the cost of implementing the system estimated at £2 million, would public awareness campaigns to encourage organ donation be a better approach?

Last year in Wales, 67 people donated organs, however the waiting list was around 300. Although there is evidence to suggest that the system could increase the number of donations by up to 25%, some countries that already operate a presumed consent system actually have lower rates of organ donation.

The Minister for Health and Social Services published a summary of responses to the bill proposal, in which 52% were in favour and 39% were against.

There are also religious views to consider:

• The Church in Wales encourage organ donation but feel it should be an ‘altruistic’ gift and not assumed.
• Views from the Muslim Council of Wales feel that their objection is not with presumed consent, but with the definition of brain death.
• Chairman of the South Wales Jewish Representative Council expresses that the family of the deceased should be able to agree with the organ being taken as a gift.

The current situation where people must die in hospital to be eligible as a donor, even if on the register, will stay the same, and the family’s wishes will remain fundamental in any decisions made.

The proposed change to the law has been backed by organisations such as the British Medical Association, British Heart Foundation, Diabetes UK, British Lung Foundation and the Welsh Kidney Patients Association.

With the backing, of these organizations, and the clear need for more organs, it seems this controversial law change will be actioned, and only at this time will we be able to properly analyse its ethical and health impacts.